In Honor Of The Mary Lanning Healthcare Centennial

In the 21st Century, we expect that hospitals and physicians, as a matter of course, will be there to provide first-rate care. It is thus hard to imagine that, in a city of 9,000, when Mary Lanning was taken suddenly ill on New Year’s Day 1910, there was no community hospital, and the available physicians were an ill-assorted lot. Mary Lanning, age 20, died on January 15, and that changed everything.

Beginning in the late 1880s, a motley succession of “hospitals” and “sanitaria” had been set up in Hastings. “Hastings Hospital” was first, its equipment consisting of cast-off linens and household goods. After several years, it disappears from contemporary newspaper records, to be succeeded by a number of proprietary “sanitaria,” promising miracle cures—for a profit. It was a ripe field for snake oil salesmen, such as the 1893 promoters of the “Bi-Chloride of Gold Cure . . . for the liquor, opium, cocaine, chloroform, arsenic and tobacco habit.” (Arsenic habit?!) Nor was medical education in much better shape.

It is ironic that Mary Lanning’s death occurred the same year the Carnegie Foundation published Abraham Flexner’s scathing description of American medical education. Flexner was a firm believer that every college of medicine should be “a branch growing out of a living university trunk.” Instead, he discovered that 457 self-styled “medical schools” had been established in the U.S. and Canada in the century between 1810 and 1910, many of them nothing but lecture-mills where “professors” collected fees from as many would-be physicians as possible, and then—with as little as six months of rote instruction, sent them out to practice. Even university medical schools were poorly organized and equipped. Here are Flexner’s comments on his 1909 visit to Creighton University in Omaha: “the provision for anatomy is poor; it comprises an ordinary dissecting-room and a lecture-room, equipped with a papier-maché model, charts, a defective skeleton, and some odds and ends of bones.”

The local implications of such hit-and-miss training may be seen in the list of physicians in the 1915 Hastings City Directory. Of 26 individuals listed, only 16 were listed as “R,” or Regular Practitioners. There were four Osteopaths (whose training, unlike today, differed radically from the Regulars’), one “Eclectic” (a school of practice which had begun, in the early nineteenth century, as a kind of herbalist rebellion against the unbridled use of substances such as mercury by mainstream medicine, but which had taken on an increasingly anti-intellectual tone as the century wore on), and five for whom no designation was given. (No one at least admitted to being a Homeopath, though that was a fourth available category.) How many of these individuals were licensed to practice medicine without so much as a high school education? There is no way of knowing. But we do know that such was not a requirement for licensure under Nebraska law at the time.

This, then, was the sorry state of health care affairs in Hastings in 1910: No hospital worthy of the name, and no guarantee that any local “physician” had ever set foot in a college. It was against this backdrop that the tragic demise of Mary Lanning played itself out.

Mary’s parents, William Holmes Lanning and Alice Tomlinson Lanning had married in August 1883, during Mr. Lanning’s term as mayor of Hastings. He was 40 and his bride was 35. As a consequence, when Mary Lanning was born, six years later, on September 8, 1889, she was destined to be an only child. Before ever coming to Hastings, however, William Lanning had led an eventful life.

W. H. Lanning was born in Tuscarawas County, Ohio in 1843, the son of Samuel Holmes Lanning and his wife, Mary. According to the late Ed Wilken (1909-1991), a long-time member of the Mary Lanning Board of Trustees, “as a 16-year-old lad knocking around the United States after leaving school in Illinois, [Lanning] had become ill of yellow fever in the South, and having experienced difficulties in finding someone to care for him then, knew of the importance of a hospital in the community.” This makes for the stuff of legend; but according to the 1860 Census, Lanning was still living at home on his father’s Ohio farm. Not to mention that the early 1860s would have been a singularly unpropitious time to be “knocking around” the South, given a certain war in progress! In any event, the documentary record for the next 15 years is frustratingly silent. He is not among veterans’ lists for the Union or Confederate Armies. He is not among those registering under the federal draft law of 1863. Nor is he among the eighteen William Lannings recorded in the federal census of 1870. What we do know is that, sometime during that span of years, he graduated from the National Normal University in Lebanon, Ohio, a prominent teacher-training academy of that era. He eventually moved to Bloomington, Illinois, where he studied law and was admitted to the bar (this per his 1919 obituary). Beginning in 1874 (and until 1927), Illinois Wesleyan University operated a law school in that city. There were no full-time faculty, but local attorneys and judges volunteered as instructors. The length of the course offered is unclear. He could have studied the law at Illinois Wesleyan for a maximum of two years, for in 1876 he reappears in the record—50 miles to the southeast, as principal of Champaign West High School in Champaign, Illinois. This was one of the college preparatory high schools for “Illinois Industrial University”—after 1885, the University of Illinois. It is illuminating to put Lanning’s higher education into perspective: In 1870, there were only 52,000 students enrolled in colleges or universities in the United States, out of a population of 38.5 million. That is 13 out of 10,000. William Lanning was an unusually well-educated man for his era—and a man who was serious about educational standards. That insistence on high standards was to come into play many years later, in the staffing of Mary Lanning Memorial Hospital.

It was apparently in Champaign that Lanning became acquainted with James B. McKinley. The two joined in a partnership, which led to William Lanning’s move to Hastings in 1879. McKinley and Lanning, incorporated in Nebraska in 1879, was technically a Pennsylvania corporation. The 1891 Descriptive and Statistical Manual of the Corporations of Philadelphia, by J. P. Crittenden and Chas. B. Helffrich, lists “The McKinley and Lanning Loan and Trust Co., Girard Bldg . . . Western Office, Hastings, Neb. Capital Authorized $500,000, par $100. Full paid. Dividends 7 p.c. per ann., payable J. and D. Annual Meeting, 1st Mon. in Dec. HISTORY—Established in 1859 at Champaign, Ill. by James B. McKinley, afterwards McKinley and Lanning at Hastings, Neb., and inc. at Philadelphia, in 1888, as the McKinley—Lanning Loan and Trust Co.” W. H. Lanning is listed as president, and is one of nine members of the loan firm’s board of trustees, along with James B. McKinley. This was the farm mortgage brokerage business that Lanning established in Hastings. And although it appears that he never practiced law, per se, his legal training would have served him well in his land business. He certainly prospered financially, and would have spared no expense to obtain the best possible medical care for his beloved daughter.

Mary was a sophomore at Smith College in Northampton, Massachusetts in the fall of 1909. That a young woman from rural Nebraska was admitted to a prestigious women’s college so far from home, testifies to both her self-reliance and her academic achievement. That she was studying social work, in an era when women attending college were overwhelmingly training to become teachers, reflects serious professional ambition. All indications are that she was thriving in that environment. No one could have foreseen the tragic outcome, when she boarded a train to return to Hastings for a holiday break in December 1909. That train ride would have taken her through Buffalo, Cleveland, and Chicago, en route home to Nebraska, over the course of two or three days—and somewhere along the way, she apparently became infected—with Salmonella Typhi, the agent of typhoid fever. Today, that disease is far more prevalent in the developing world. In 2015, the Centers for Disease Control offers this succinct advice to foreign travelers: “Boil it, cook it, peel it, or forget it.” But in the United States in 1909, in the closed environment of a long-distance journey by train, multiple opportunities for contamination of food or water could have presented themselves. The mention of additional diagnoses, in newspaper accounts at the time of her death, as well as in later accounts, actually lend credence to the diagnosis of typhoid fever. It is a “great imitator,” which can be baffling in its presentation, clinical course, and complications.

The great William Osler gave typhoid due prominence as the first subject in his 1893 Principles and Practice of Medicine: 39 pages, including multiple graphs of fever patterns, blood count alterations, and an extensive review of complications, system by system. As far as the lungs are concerned—“pneumonia” being another explanation offered for Mary’s demise—Osler notes that an “ordinary lobar pneumonia” can actually be the initial symptom of typhoid fever, “the intestinal symptoms [not developing] until the end of the first week or later.” But pneumonia can also be “a serious and by no means infrequent complication of the second or third week,” occurring in over 8% of cases in one series cited by Osler. Doctors Hare and Beardsley, in their 1909 Medical Complications, Accidents, and Sequels of Typhoid Fever—a volume of over 400 pages!—also speak of pneumonia as a complication, either by direct invasion of the lung by the typhoid bacillus, or by a secondary infection with the Pneumococcus.

Whatever Mary’s precise clinical presentation and course may have been, her death certificate, on file with the Nebraska Department of Health and Human Services, is definitive. I quote from that document, with the portions filled in by her attending physician underlined: “I HEREBY CERTIFY, That I attended deceased from Jan 2nd 1910 to Jan 15th 1910 that I last saw her alive on 15th Jan 1910 and that death occurred, on the date stated above, at 2 M. The CAUSE OF DEATH was as follows: Typhoid. Contributory [a long horizontal line drawn in] (Duration) [another long horizontal line] Signed C. V. Artz M.D.”

Care was obtained for Mary, of course. Newspaper accounts at the time of Miss Lanning’s death refer to her being attended by both Doctors Charles V. Artz and Frank Schaufelberger. Becoming alarmed at her deteriorating course, they called in Dr. Milton H. Everett of Lincoln, for consultation, on the night before her death. As for experience, Dr. Artz had been practicing in Adams County since 1893, Dr. Schaufelberger since 1894. They were among only 13 physicians listed in the 1895 Hastings City Directory. (Though only Dr. Schaufelberger later appears among the Mary Lanning Hospital medical staff, Dr. Artz ironically lived right behind the newly-opened hospital, at 755 N. Denver Avenue.) Dr. Everett, likewise, was an experienced practitioner; for he had been involved in a brouhaha in the Lincoln medical society way back in 1888, when, having been appointed assistant surgeon for the Burlington Railroad, he found himself accused of unprofessional conduct: consulting with homeopathic and eclectic practitioners! (He was ultimately exonerated, although the particulars of any investigation are lacking.) There is obviously fertile ground for speculation in several of these details, but nothing in the way of proof. All we know for certain is that the three physicians treating young Miss Lanning had a combined 55 years of practice experience. We know nothing about their overall education or medical training.

Ultimately, no matter how experienced or caring they were, in the pre-antibiotic era, typhoid fever was a challenging disease to treat—even with the kinds of laboratory evaluations available in a university hospital. These men were limited to bedside exams in a private home, trying to care for a typhoid fever victim with no lab testing available—none. Nor could they have offered Mary detailed monitoring, or fluid support, or any of the other basic hospital services we take for granted today. The conclusion seems inescapable: Faced with a young life gone seriously awry, these men did all that they could with the treatments available to them, but it was not nearly enough to halt the course of this dreaded disease. Try to imagine the quiet desperation, then, in that large house on the northwest corner of 7th Street and Hastings Avenue, on the afternoon of Saturday January 15, 1910, as the Lannings watched their daughter slip away. Deterioration—coma—death.

Not ones to sit idly by in their grief, the Lannings spent the next several years visiting hospitals throughout the United States and Europe, educating themselves in the essentials for a first-rate hospital. Flexner’s report was much in the news at the same time, and as a college-educated man himself, William Lanning no doubt took heed of the kind of scientific medical training and medical staff organization that would befit an institution founded in his daughter’s memory. After a little more than four years, they were ready to proceed. Following an organizational meeting on March 24, 1914, Articles of Incorporation for the Mary Lanning Memorial Hospital Association were filed on March 25th. The hospital was to be organized as a non-profit institution. The first seven trustees were William Lanning himself (71), attorney C. F. Morey (66), banker J. N. Clarke (78), bank president Charles G. Lane (52), dry goods store owner George H. Pratt (69), grain business owner Christian Koehler (66), and last but not least, Thomas Frahm (49), a loyal employee in William Lanning’s business since age 17. Frahm was to serve as trustee—with one three-year interruption—until his death at age 95 in January 1961. All but Frahm were prominent citizens of Hastings in 1914; and all but two might have been called “city elders,” for these five were in their mid-60s or older. Thus, from the outset, they were thinking about the trustees who would soon replace them.

It is interesting to this writer that, while William Lanning himself was without church affiliation, according to those original Articles of Incorporation, “no two of [the trustees] shall at any one time be members of the same church or religious organization.” Considering the ongoing tensions between medical science and certain church doctrines, this seems an amazingly prescient qualification—and one that has served Mary Lanning well.

Similarly, Lanning was quite adamant about the hospital’s non-profit status, very broadly construed. On August 31, 1915, when the hospital had been open barely seven months, he found himself needing to remind his fellow trustees that:

It has been the object from the beginning to exclude everything that in any way might lead to a special privilege or might result in exploitation by any officer or employee inside or outside the institution. We went so far in our charter as to write in a provision that no relative of a Trustee — either by blood or marriage — should ever hold a salaried position in the Hospital... No connection with the Institution by anyone in any capacity must ever be used as vantage ground from which the personal fortunes of such person may be promoted. I trust that in the future this may be kept constantly in view... Every dollar of endowment coming from me will be accompanied with this provision — and a failure to adhere to this principle will result in the loss of the endowment. Applying this principle to the case of the House Physician — which has been under discussion — I do not see how a person within the Hospital and drawing a salary from the Hospital can be allowed to practice his profession for personal gain, either in or out of the Institution without a total subversion of the principle we have undertaken to enforce.

Who this “house physician” was, in this first few months of the hospital’s operation, is unclear. Was he Lanning’s version of a “hospitalist,” over 85 years before that term came into common usage? Or simply a medical staff position modeled after something Lanning had seen in Europe? Whoever it was, he apparently came to a quick parting of the ways with Lanning and his board when he tried to carry on a private “fee for service” practice on the side.

Mary Lanning Memorial Hospital was dedicated on January 21, 1915. Six operations were performed in the hospital that first day, case number one being an appendectomy for “chronic appendicitis” carried out by Dr. W. J. O’Hara—a name that does not appear among the list of Adams County physicians in Tyler’s History, nor among the names of the Mary Lanning medical staff, as first organized in 1920. He was first registered to practice in the county in 1910, and is listed as a physician in the Hastings City Directories for 1912 and 1915—but he disappears from the record thereafter. Could this be the “house physician” who quickly came to loggerheads with William Lanning? Again, the record is silent as to the man’s name. In any event, Dr. O’Hara’s patient was a 13 year old male, admitted to the hospital January 20 and discharged February 3. My, how hospital lengths-of-stay have changed!

November 1918—in the days surrounding the Armistice—the hospital faced a crucial decision: to admit, or not to admit, victims of the great influenza pandemic. Understand that Mary Lanning was primarily a surgical facility in those early days; of the 46 patients admitted in October 1918, 29 were surgical cases. The general policy had been that the hospital was not equipped to deal with infectious diseases, although there were exceptions: Two cases of typhoid fever had been admitted that month, for example. Then on November 14, 1918, in response to the exploding epidemic, an entire ward was set aside for treating influenza patients. These constituted over half of the hospital admissions over the subsequent three weeks, including bacterial complications of influenza, such as empyema (pus in the chest cavity, requiring surgical drainage). Did William Lanning, as chairman of the Board of Trustees, play a role in this change in policy? The record is silent. But the memories of his daughter’s death from an infectious disease would surely have haunted him in that dark November.

Alice Lanning had died in January 1918, and William Lanning’s death followed in April 1919. But by then, the institution he had envisioned—one of education as well as caring—was well on its way. For, coincident with the founding of the hospital, was its school of nursing, which, over the next 73 years, graduated a total of 1,453 Registered Nurses. (In 1988, faced with a nationwide trend of closure of hospital-based schools of nursing, in favor of college-affiliated baccalaureate programs, Leota Rolls, Mary Lanning School of Nursing graduate and assistant hospital administrator, negotiated an affiliation with the Creighton University School of Nursing which endures to this day.) Similarly, when the medical staff was first organized into departments in 1920, departmental meetings were matters of “continuing medical education,” long before that became a buzzword in the national discussion.

Dr. Eugene C. Foote (1879-1979), founder of the Foote Clinic in 1908, whose own postgraduate medical education and experience had extended to Europe and Asia, was the first chief of the medical staff. He also headed up the Eye, Ear, Nose, and Throat Department. Obstetrics was headed by Dr. Frank Schaufelberger (whom we’ve already mentioned), Pediatrics by Dr. C. B. Spicer, Internal Medicine by Dr. E. B. Hamel, and Surgery (after 1922) by Dr. C. B. Calbreth. Their staff meetings were case review conferences, in which it appears that all cases dismissed from a particular clinical service the previous month were discussed—and critiqued. No bureaucratic humdrum in the medical staff meetings of the 1920s! Between 1921 and 1931, thirty new physicians were admitted to the medical staff at Mary Lanning, including a pair who were still in practice here in the late 1970s: Dr. Otto Kostal (1926) and Dr. D. W. Kingsley, Sr. (1928). And a number of poorly-qualified candidates were denied staff admission. High standards for medical and nursing care were set and maintained.

National accreditation followed. The American College of Surgeons had been founded in 1913, with one of its goals being what was called “the end result system of hospital standardization.” This meant that a hospital would track every patient it treated long enough to determine whether the treatment employed was effective. And if not, to determine why not, so that similar cases might be treated more successfully in the future. Its “Minimum Standards for Hospitals” (like the Flexner Report, funded by a Carnegie Foundation grant) were published in 1917. They filled exactly one page! Nonetheless, when on-site inspections of hospitals began in 1918, only 89 of 692 hospitals surveyed met the requirements. An 18-page “Standards Manual” followed in 1926. By 1928, 16 Nebraska hospitals had achieved A.C.S. accreditation, 11 of which were in Lincoln or Omaha. Mary Lanning was first visited by A.C.S. inspectors shortly thereafter. A number of suggestions were made, which might enable the hospital to achieve A.C.S. accreditation. The largest stumbling block was the lack of a qualified pathologist to review surgical tissue samples in a timely fashion. That deficiency was addressed through an arrangement with a Lincoln pathologist. And so, on October 9, 1933, Franklin H. Martin, Director General of the A.C.S., wrote, “Your hospital has been awarded Full Approval by the American College of Surgeons for the year 1933.”

Twenty years later, the A.C.S. transferred its hospital-accreditation program to the newly formed Joint Commission on the Accreditation of Hospitals. The JCAH released the results of its first survey of hospitals in March of 1954, listing 2,920 hospitals as fully-accredited, out of about 7,500 total hospitals in the United States and Canada. Mary Lanning was one of 24 hospitals duly accredited in Nebraska, and one of only 11 outside Lincoln and Omaha.

Mary Lanning Memorial Hospital had been in operation barely a decade when the first addition to the building was carried out. This was the Alice T. Lanning maternity wing, constructed in 1926. Reflecting the rapid growth in hospital (as opposed to home) births, the obstetrical service provided in that building continued to grow over the years, reaching an as-yet-unsurpassed total of 992 births in the Baby Boom year of 1955. The hospital pharmacy opened in 1939, just in time for the advent of antibiotic therapy. Penicillin was first employed at Mary Lanning in April 1944. Hastings’ rapid growth during the war years created demand for additional hospital beds, a need that was highlighted by hospitalization of a number of the 53 injured survivors of the Naval Ammunition Depot explosion in September 1944. The following year, new kitchen and cafeteria facilities, along with a new wing of 40 additional beds, were opened.

The late Forties brought a new infectious challenge: polio. The first case of what was commonly known as “infantile paralysis” had been diagnosed in Adams County only in 1916. Its late appearance was due to the fact that, unlike a disease such as typhoid fever, this was a disease that was fostered by improved sanitation! Basically, lacking small, repeated oral exposures to the virus in drinking water in infancy led to a total lack of immunity upon community exposure later in childhood—with devastating results. From the 1920s on, the number of cases varied widely from one year to the next; but the vast reservoir of Baby Boom children presented the opportunity for an epidemic increase. The neuromuscular failure associated with the disease could afflict anything from the legs to the lungs—the latter necessitating treatment in a so-called “iron lung,” a body-encasing metal cylinder through which alternating positive and negative pressure was applied to the chest wall, to keep the air moving in and out. Imagine the noise made by 10 or 15 of those machines in one ward, simultaneously pumping and sucking away, as they were in the epidemic year of 1952! Recognizing the hospital’s leadership role in polio treatment, the National Foundation of Infantile Paralysis designated Mary Lanning as a 32-bed regional polio treatment center in June 1953. While this led to a lasting expansion of physical therapy options for treatment in the hospital, the polio ward itself was mercifully short-lived after the Salk polio vaccine arrived in Hastings in April 1955.

The early 1950s brought additional changes, both in available technologies and in the number of hospital beds. Specifically, a new $65,000 X-ray department opened in March 1953, under the direction of Dr. Warren Richard, who was to head the Radiology Department for decades to follow. This included a “deep therapy X-ray machine used in the treatment of malignant diseases and tumors.” This was the beginning of radiation therapy at Mary Lanning. The Frahm addition to the hospital, given by long-time trustee Thomas Frahm, was completed in 1954.

The subsequent sixty years have brought repeated upgrades in the bricks and mortar aspect of Mary Lanning Hospital. 1970 saw the completion of the seven-floor north tower addition to the facility, which dwarfed the original three-story structure—and all its various add-on wings. The Medical Services Building was completed in 1994. The pre-1970 hospital building was razed in 2000, to provide space for construction of a new suite of operating rooms (including the outpatient Surgery Center) and a new Emergency Department, which tripled the size of its predecessor. The Morrison Cancer Center opened in 2004. 2011 saw completion of the Century Project, with a new and expanded Birthing Center and Intensive Care Unit.

In 2011, William Lanning’s tribute to his daughter received a new name, reflecting the broad range of services it provides: Mary Lanning Healthcare. As stated on the hospital’s website, “Today, Mary Lanning Healthcare serves patients throughout central Nebraska. It is licensed for 183 beds and employs a staff of nearly 1,000. Mary Lanning Healthcare is the largest employer in Adams County, with an annual payroll of more than $35 million.”

These are the kinds of projects and statistics upon which marketers may reasonably dwell. Instead, I’d like to focus on some of the people who, by their long-term commitments, have made Mary Lanning the kind of facility in which I was proud to practice.

Mary Lanning has never been a stopping-off place, but a destination. I remember when I served on the search committee for a new hospital administrator, back in 1988. The hired consultant, remarking on Jim Kenney’s 34 years of service in that capacity, cautioned us: “You’re not going to get someone for 34 years! Six is about the average.” He was right. Mr. Kenney’s successor, Mike Kearney, only stayed for—21 years.

Career-long service to Mary Lanning is even better exemplified by Leota Rolls, whom I’ve already mentioned. Other than one year spent at the University of North Carolina, where she earned her Master’s Degree in Nursing (1968-9), she served Mary Lanning Memorial Hospital continuously from 1963 to 2011—47 years altogether. Beginning as a new staff nurse in ’63, she earned her B. A. at Hastings College in 1965, and became an instructor in nursing. Upon her return from UNC in 1969, Miss Rolls became Mary Lanning’s Director of Nursing Education, and after 1980, served as an adjunct professor with the Creighton University School of Nursing. She also devoted many years of service to state and national nursing boards and associations. But her first priority was always local: maintaining a high standard of nursing professionalism at Mary Lanning Hospital.

From this physician’s perspective, however, Leota Rolls’ involvement in hospital administration, as Mary Lanning’s Senior Vice President (1980-2011), was equally important. As a class, hospital administrators can be exceptionally well trained in business plans and balance sheets, but frustratingly unimaginative when it comes to preventing damaging collisions at the poorly-lit intersection of Clinical Care and Bureaucratic Procedure. Because of her hands-on knowledge of patient care, Miss Rolls was often summoned to “direct traffic” in such situations. She helped prevent many a nasty pileup. And egos were seldom dented, because she was perfectly happy achieving results behind the scenes.

Finally, those 47 years of service gave her the kind of institutional memory that helped keep Mary Lanning true to its core values. During her 31 years as Senior VP, there were 14 different trustees, and three different administrators/CEO’s, but only one Miss Rolls. Because she thoroughly understood the culture of the institution, she could help facilitate its evolving clinical services, while finding creative ways to maintain its independent status in an industry full of consolidations and for-profit spinoffs. Her contributions to keeping the institution on track are considerable, and I honor them here.

Another long-term contributor to Mary Lanning history was the late Richard Spady. A Hastings native, he had earned a masters degree in agricultural economics and farm management at the University of Nebraska-Lincoln School of Agriculture, and had worked at the Nebraska Game and Parks Commission from 1958 to 1974, rising to assistant director by the latter year. Spady was recruited to join the McKinley and Lanning firm. Dick once told me that when he came back to Hastings, the hospital grounds “looked like the Pentagon”—austere, imposing, and barren. The stately trees that had once surrounded the hospital were gone, victims of Dutch elm disease. Nor had the land clearing associated with construction of the seven-floor north tower helped matters.

When his father John died in 1975, Dick Spady not only succeeded him on the hospital Board of Trustees, working with the rest of his family, he set about creating a landscape plan for the entire hospital grounds as a living memorial to his parents. He believed fervently that the beauty of living nature, in all its diversity, is crucial to the healing process. This symbiosis—different organisms living in close physical association to their mutual benefit—stands in contrast to infectious disease, where the process is one of predation: one organism feeding on another. And while much of the work of the modern hospital involves the pharmacologic treatment of infectious disease, Mr. Spady liked to say, “We don’t just pump people full of chemicals here.” I can personally testify that he was a very hands-on landscaper, not someone who just wrote a check for some unseen nurseryman to come in and plunk something into the ground. He was there himself, shovel in hand, envisioning the angle at which the light would strike a particular tree or shrub, and how that planting would contribute to the whole landscape. I’ve heard it said that, in landscape design, one should never say, “I want a ________,” but “I want to do ________.” And Dick Spady was always doing. As a consequence, since 1976, over 500 varieties of plants, and over 10,000 individual plantings, have been added to the Mary Lanning campus. And though Dick has left us, his vision of healing remains, as central to the ethos of Mary Lanning as having the latest technologic gizmo.

My third exemplar of long-term service to Mary Lanning is Mrs. Margaret Zimmerman, who practiced as an obstetric nurse from 1968 to 2003. We spent many an hour in the delivery room together, privileged to attend the birthing process, while ever alert for complications arising. In my observation, her calm competence allayed many a new mother’s fears. She had begun her career in the old Alice Lanning obstetric suite, which she described as having a number of small labor rooms, no monitors, either blood pressure or fetal, and hardly ever an I.V. In contrast to the present 1:1 ratio of nurse to laboring patient, it wasn’t uncommon for her to be alone, in charge of three women in labor. After time off for childbirth herself (her son Tim, born 1970, is now on the Mary Lanning medical staff), she returned to work just in time for the opening of the new north tower, in November 1970. The labor rooms were much bigger. Soon automatic blood pressure monitors and fetal monitors put in an appearance. Margaret describes the former as a “tremendous help”—the latter as more of a mixed blessing. She recalls instances where a physician was a little too fixated on the technology, walking into the labor room, intently studying the fetal monitor, and walking out again, without so much as looking at, much less saying a word to, the laboring patient!

Despite the impressive new surroundings, the staffing level was sometimes still a concern. As Mrs. Zimmerman describes those days, the norm had advanced to two nurses for three laboring patients, but it wasn’t uncommon for that second nurse to be pulled for duty elsewhere, to the I.C.U., for example. On one such hectic evening by herself, all the patients having been successfully delivered of healthy newborns, Margaret was catching up on her charting, along about midnight, when she belatedly discovered a six-minute drop into the 50 beats-per-minute range in one fetal heart tracing, less than half the lower limit of normal! This had gone unseen while she was assisting at another patient’s delivery. Had she seen it, it would have been grounds for an immediate C-Section. And yet—all had turned out well. Perhaps the baby was transiently lying on its umbilical cord. In any event, it shows that medical technology can provide us with an incredible amount of information; but the interpretation of that information is not always as cut-and-dried as we’d like to think.

We are left with the human element of caring. Mrs. Zimmerman, just like Miss Rolls and Mr. Spady, cared. She speaks of how “it was always a joy to see a new baby born.” Birth and death, the core mysteries of human experience, will always trigger our deepest needs to care for one another. James Joyce wrote,

Of the dark pastA child is bornWith joy and griefMy heart is torn.

Calm in his cradleThe living liesMay love and mercyUnclose his eyes!

Let us consider some of the changes wrought in medicine and society since William Holmes Lanning, with joy and grief, opened his daughter’s memorial hospital. Change is said to be borne on the wind. In Nebraska, we certainly know about wind! There are those gentle Spring breezes, perhaps out of the south, that speak of rebirth. Those changes have brought us things unimaginable in 1915: antibiotics, cures for cancer, neonatal intensive care—the list goes on. There are also those tornadic prairie winds, kicking up grit that can blind us to the wider purpose: unforeseen epidemics, hospital conglomerates, for profit start-ups cherry picking the most lucrative cases—these, too, would have held an Alice-in-Wonderland quality for William Lanning; although, given his life experience, I suspect he would have seen through the for-profits with a good deal of contempt. Then there are those gusts out of whatever direction, that are pretty much a daily accompaniment to life on the plains: Let them be akin to Medicare, and Medicaid, and the endless Third-Party Reimbursement Wars that characterize medical finance in the 21st century, and you have another change unforeseeable in 1915. And yet, Mary Lanning Healthcare stands. Not unaffected, certainly, but resilient in the face of those many winds of change. Here to serve. Here to care.

About the Author:

Harry E. Salyards, M.D. is a long-time member of the Adams County Historical Society and former ACHS board member. He practiced Family Medicine in Hastings from 1977-2011. He was Chief of the Mary Lanning Medical Staff in 2001-2002.

Acknowledgements:

The author would like to thank Mary Plock, of the Mary Lanning Healthcare Foundation, for providing materials from the Mary Lanning archives. (Just as he again thanks Charlene Diers for similar assistance with his 1997 article, cited below.) He would also like to acknowledge the late Dr. John G. “Jack” Yost, who gave him his copies of Osler and Tyler, likewise cited below. The latter was particularly helpful in capturing a sense of medical practice in Nebraska in the early years of the 20th Century. He also wishes to thank the many women and men of Mary Lanning Memorial Hospital who, for 34 years, helped him live his childhood dream of practicing medicine. Just because you are not mentioned by name in this article does not mean that you are not fondly remembered! Finally, he would like to thank his loving wife, Phyllis S. Salyards, M.D.—partner in practice as well as in life, who offered many suggestions that materially improved this article.